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Tried for murder of patient

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The corridor outside the courtroom was crowded with foes of Dr. Kevorkian, many in wheelchairs, who burst into applause after the sentencing. Dr. Kevorkian, who had talked on a cellular telephone in court before the sentencing, smiled as he was led out by bailiffs. He had declined to speak in his defense.

A jury convicted Dr. Kevorkian on March 26 of second-degree murder in the death of Thomas Youk, a 52-year-old man who lived in suburban Detroit and suffered from amyotrophic lateral sclerosis, or Lou Gehrig's disease. His widow, Melody Youk, gave a statement to the court today that bitterly criticized prosecutors and cast Dr. Kevorkian as someone who was merely carrying out the wishes of her husband.

Saying that she wished she had been able to speak at the trial, Mrs. Youk said that her husband ''would be greatly distressed that the man who brought him peace at the end would now suffer on his account.''

She said Mr. Youk, an accountant who worked on vintage cars as a hobby, had decided before contacting the doctor that he wished to end his life. ''I was crushed,'' she said. But she said she had bent to her husband's wishes.

Mr. Youk had tried several experimental drugs and therapies, she said, but he had virtually lost all use of his body. ''My husband had come to the end of his life as he chose it,'' she said. ''He was not depressed. He was not a victim.''

But John Skrzynski, the prosecutor, said Dr. Kevorkian had used Mr. Youk as part of his effort to rally support for euthanasia.

''The defendant chose to put us in this sad situation,'' he said. ''This is not a case where the prosecutor went looking for Dr. Kevorkian.''

The doctor must serve more than six years before being eligible for parole under Michigan guidelines.

One of his lawyers, Michael Schwartz, said that on hearing the sentence Dr. Kevorkian had softly uttered, ''Justice?''

Judge Cooper told Dr. Kevorkian that whatever his views on euthanasia, he must follow the rules of a democratic society.

''We are a nation of laws,'' she said. ''We have a civilized and nonviolent way of resolving conflict. You can criticize the law. You can gripe. You can lecture. You can petition the voters. But you may not take the law into your own hands.''

The judge noted that voters in Michigan last November defeated by a wide margin a measure that would have legalized assisted suicide.

She said that the law was clear.

''When you purposely inject another human being with what you know is a lethal dose, that, sir, is murder.''

She also noted that Dr. Kevorkian had lost his medical license in Michigan eight years ago, and had no permission to hold the sorts of toxic drugs he used to kill Mr. Youk.

''You had no right to be in control of any kind of controlled substance, let alone deliver it to someone else,'' she said.

She said she was denying bond because she did not know whether Dr. Kevorkian could be trusted to stop assisting suicides, even though his lawyer Mayer Morganroth said he had made such a promise.

''I question whether you will ever cease and desist,'' the judge said.

Mr. Schwartz criticized the sentence as unduly harsh. He also noted that Dr. Kevorkian had recently indicated he would go on a hunger strike in prison.

''This is a civil rights case,'' Mr. Schwartz said in an interview after the sentencing. ''This was not about Jack Kevorkian.''

Saying that Dr. Kevorkian is ''not some cold-blooded murderer,'' Mr. Schwartz said he failed to understand how the judge could view him as a threat to society.

Terrence Youk, a brother of Thomas, said that he found the sentence ''outrageous, but not surprising.''

In the courtroom, Mr. Youk had urged the judge to show leniency for Dr. Kevorkian, and charged that prosecutors had been ''disingenuous'' by casting his late brother as a victim of the doctor's.

''Tom fought the courageous and inspired fight,'' he said. But he said his brother had become ''a prisoner in his own body.''

He said he would have spasms of choking on his own saliva. ''He was caught in hell,'' his brother said, his voice breaking.

He said his brother had ultimately decided to die ''from a stable, well-informed point of view.''

He said his brother had often lamented that he did not want to die, but that he could not go on living.

Terrence Youk accused the prosecution of hypocrisy.

''Why doesn't the prosecutor charge me with conspiracy to commit murder?'' he said, saying that he had composed his brother's letter to Dr. Kevorkian and arranged their initial meeting.

He said his brother's intentions had been very clear. ''This was no one else's decision but his,'' he said. ''History will judge us harshly for such a lack of insight and compassion.''

This was the fifth time that prosecutors had tried Dr. Kevorkian in the deaths of seriously ill people. Three trials ended in acquittal. A fourth ended in a mistrial. In those cases, he had not been charged with murder but with violating laws against assisted suicide. In some cases, families of the dead had given emotional statements defending him.

But this trial, at which Dr. Kevorkian insisted on defending himself, was different because prosecutors were able to use a videotape Dr. Kevorkian made of himself injecting Mr. Youk with lethal chemicals in September. Dr. Kevorkian took the tape to the CBS News program ''60 Minutes,'' which broadcast it in November along with an interview in which Dr. Kevorkian dared prosecutors to file charges against him.

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Kevorkian Sentenced to 10 to 25 Years in Prison

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Oakland County Circuit Court Judge Jessica Cooper sentences Dr Jack Kevorkian to 10 to 25 years in prison, despite emotional pleas on his behalf from widow and brother of Thomas Youk, terminally ill man he was convicted of killing; denies bail to Kevorkian, who plans to appeal, and says his

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Summary of Most Important US Court Cases

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Court Cases (Assisted Suicide) " Wisconsin Right to Life

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Assisted suicide court case information from Wisconsin Right to Life

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Families' views and reactions to PAS- Oregon

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California and Oregon history

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California's wrenching yearlong legislative debate over the right to die culminated Monday with Gov. Jerry Brown signing into law a bill making California the fifth state to permit physician-assisted suicide for the terminally ill.

As a Democrat and former Catholic seminarian, Mr. Brown was caught between two opposing sides of the right-to-die debate, and had given little indication of whether he would sign the bill before it reached his desk in early September.

"In the end, I was left to reflect on what I would want in the face of my own death," Mr. Brown said in his signing statement. "I do not know what I would do if I were dying in prolonged and excruciating pain. I am certain, however, that it would be a comfort to be able to consider the options afforded by this bill. And I wouldn't deny that right to others."

Groups like Not Dead Yet and Californians Against Assisted Suicide had joined the Catholic Church in opposing the legislation, arguing that it would place pressure on the ill and disabled to end their lives rather than run up large health insurance bills.

"This is a dark day for California and for the Brown legacy," said Californians Against Assisted Suicide spokesman Tim Rosales in a statement.

"As someone of wealth and access to the world's best medical care and doctors, the governor's background is very different than that of millions of Californians living in health care poverty without that same access - these are the people and families potentially hurt by giving doctors the power to prescribe lethal overdoses to patients," Mr. Rosales said.
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Oregon became the first state to legalize assisted suicide for terminally ill, mentally competent adults in 1994, followed by Washington and Vermont. The Montana Supreme Court has ruled that physicians may prescribe lethal drugs to the competent terminally ill.

The was thrust back in the limelight this year after the highly publicized case of 29-year-old Brittany Maynard, who moved from California to Oregon to end her life after being diagnosed with terminal brain cancer.

"The crux of the matter is whether the State of California should continue to make it a crime for a dying person to end his life, no matter how great his pain or suffering," Mr. Brown said in his statement.

"I have carefully read the thoughtful opposition materials presented by a number of doctors, religious leaders and those who champion disability rights," he said. "I have considered the theological and religious perspectives that any deliberate shortening of one's life is sinful."

Mr. Brown said he also discussed the End of Life Option Act with "a Catholic Bishop, two doctors and former classmates and friends who take varied, contradictory and nuanced positions."

Foes of the legislation argued that state Democrats gamed the process by introducing the bill during a special session designed to deal with Medi-Cal funding, rather than during the regular legislative session, when the matter would have received a more thorough hearing.

In fact, a nearly identical bill died earlier this year after stalling in the Assembly Health Committee and under enormous public opposition from religious and disabled rights groups, despite strong Democratic support in the state Assembly and Senate.

Democratic state Sen. Lois Wolk, a supporter of Assembly Bill 2x-15, posted a message shortly after the bill-signing saying, "Thank you Governor Brown for providing all Californians the right to a peaceful death. History was made today."

Supporters of right-to-die legislation predicted that the California bill would have a ripple effect in other state legislatures.

"The Governor's decision is certain to reverberate across the nation," said George Eighmey, vice president of the Death with Dignity Political Fund in a fundraising appeal issued Monday.

"More remains to be done in California to ensure smooth implementation of the law and even more in 46 additional states that do not have a Death with Dignity law," he said. "But for now, please join us in celebrating freedom winning the day."

While the Maynard case re-energized the right-to-die debate, Californians have been wrestling with the issue for more than two decades. Voters rejected an assisted suicide ballot measure in 1992, while the state legislature had repeatedly rejected previous bills.

The newly signed law takes effect 90 days after the end of the special legislative session, which could extend until after the start of the year.

Mr. Rosales said the coalition opposing assisted suicide is "reviewing all of its options," which could include a statewide ballot measure to repeal the law.

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California fifth state to allow physician-assisted suicide

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California's wrenching yearlong legislative debate over the right to die culminated Monday with Gov. Jerry Brown signing into law a bill making California the fifth state to permit physician-assisted suicide for the terminally ill.

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Lists of Court Cases

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History and court cases

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Physician-assisted suicide involves the hastening of death through the administration of lethal drugs, upon request of the patient. Physician-assisted suicide is sometimes known as active euthanasia. It differs from withholding or discontinuing medical treatment in circumstances that will result in death. Withholding or discontinuing medical treatment is sometimes called passive euthanasia. Passive euthanasia is generally accepted, although not without controversy, in the United States as an individual's right to refuse medical treatment. Examples of passive euthanasia include turning off respirators, stopping medication, discontinuing food and water, or failing to resuscitate.

The Hippocratic Oath has been used by physicians as a code of ethics for more than two thousand years. Attributed to Hippocrates, (ca. 460-370 BCE), the oath provides in part: "I will follow that method of treatment, which, according to my ability and judgment, I consider for the benefit of my patients, and abstain from whatever is deleterious and mischievous. I will give no deadly medicine to anyone if asked, nor suggest any such counsel.

The American Medical Association takes this stance: "It is understandable, though tragic, that some patients in extreme duress-such as those suffering from a terminal, painful, debilitating illness-may come to decide that death is preferable to life. However, allowing physicians to participate in assisted suicide would cause more harm than good. Physician-assisted suicide is fundamentally incompatible with the physician's role as healer, would be difficult or impossible to control, and would pose serious societal risks."

Dr. Jack Kevorkian, self-styled "Dr. Death," has garnered much publicity for his role in physician-assisted suicides. Kevorkian escaped conviction on murder charges several times during the 1990s as he assisted in numerous suicides. Kevorkian operated on his own set of rules to determine whom he would assist; he supposedly assisted more than 130 patients. When he began, Michigan did not have a law that specifically prohibited assisted suicide. As his notoriety grew, the Michigan legislature passed a law prohibiting assisted suicide. The Michigan Supreme Court upheld the statute in 1994, ruling that no constitutional right to suicide exists, including assisted suicide. Kevorkian's second-degree murder conviction was upheld.

The Supreme Court has determined that no right exists for physician-assisted suicide. However, states are free to enact laws to permit it. Oregon is the only state that currently permits physician-assisted suicide. Technically, however, a death under Oregon's Death With Dignity Act is not considered suicide, assisted suicide, or homicide. Oregon's law has survived numerous legal challenges since its enactment in 1994. In January 2006, the United States Supreme Court the law against former Attorney General John Ashcroft's attempt to render the statute illegal under federal law.

In 1997 President William Jefferson Clinton signed the Assisted Suicide Funding Restriction Act of 1997. The law's intent was "to clarify Federal law with respect to restricting the use of Federal funds in support of assisted suicide," euthanasia, or mercy killing. The act banned the funding of assisted suicide through Medicaid, Medicare, military and federal employee health plans, veterans' health care systems and other federally funded programs. It also prohibited the use of taxpayer funds to subsidize legal assistance or other advocacy in support of legal protection for assisted suicide.

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Physician-assisted suicide involves the hastening of death through the administration of lethal drugs, upon request of the patient. Physician-assisted suicide is sometimes known as active euthanasia. It differs from withholding or discontinuing medical treatment in circumstances that will result in death. Withholding or discontinuing medical treatment is sometimes called passive euthanasia.

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Timeline, states involved, and court cases

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Physician-Assisted Suicide Fast Facts | CNN

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Read CNN's Fast Facts on physician-assisted suicide.

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Physician reactions to PAS

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Personal story about making their decision

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I was living in comfortable retirement with my wife, Mathilde, when, at the age of 71, she received a diagnosis of Waldenstrom's disease. The chief danger of this rare cancer of the bone marrow is that it impedes and eventually destroys the production of vital components of the blood supply.

It was held at bay by periodic bouts of chemotherapy, sometimes for a few months, once for several years. And for a long time, we lived our lives under this regime, citizens of the realm of the chronically ill, with monthly visits to the cancer hospital for checks and tests, always wary of the disease. But this soon became a routine, and for long spells we did not feel seriously threatened, taking a quick holiday when another round of chemotherapy was in the offing. Apart from fatigue and the common effects of advancing age, Mathilde did not suffer very much.

Then, after seven years, the cancer suddenly turned aggressive and the treatment no longer worked. The disease had soon wrought havoc among the leukocytes, the white blood cells that guard against infection, and all of Mathilde's resistance had gone. It was just a matter of time - a couple of weeks or maybe months - before she would die from influenza or some other common infection. At the hospital, they gave her a blood transfusion and told her to report next week; and then they gave her another blood transfusion and told her to report again a week later. And if she had not fallen ill and refused further treatment, they would no doubt have continued in this way.

But we live in the Netherlands, and here is where our story becomes a little different. When people become as ill as my wife, with no prospect of cure and only pain and exhaustion in the offing, it is quite legal to end one's life by voluntary euthanasia.

For all her quiet ways, Mathilde was a strong-willed person, cherishing her independence and her freedom, and determined to live her life as she wanted. When euthanasia first became a public issue in the early 1970s, she became a strong supporter of the cause. We joined the Dutch Association for Voluntary Euthanasia, signed petitions and wrote letters to members of Parliament demanding such a law. When, as a first step, our courts set out conditions that made euthanasia acceptable, Mathilde, then only in her 40s, made sure we filled out the forms with the association stating that we wanted to receive euthanasia when the time came.

In 2001, euthanasia finally was fully legalized. Those who wanted it had to ensure the cooperation of their family doctor. We made sure all the doctors who joined our village medical practice knew our wishes, and we always asked whether they would administer euthanasia. As an added precaution, Mathilde continued to carry a thick wad of forms and declarations in her handbag wherever she went, in case of an accident.

All the doctors agreed to our request. They were from a younger generation; it is older doctors, mainly, who are reluctant to administer euthanasia. A few refuse on grounds of principle, others because they just do not wish to become involved. But more than 80 percent of all Dutch family doctors, according to a recent large study, report that they have performed euthanasia at least once, and among the willing doctors the average rate is once every two or three years.

Euthanasia is by now widely accepted here. It is supported by the vast majority of the population, of the medical profession and of the political parties. The costs for it are borne by our compulsory health insurance, and suicide clauses voiding life insurance policies have been set aside. Still, it is an onerous task for the attending physician, and it also demands paperwork and careful planning. Demands for euthanasia are not made lightly and are more often denied than granted, largely because of insufficient forethought.

But in Mathilde's case, forethought had not been lacking.

Waiting to fall ill

When it was clear that Mathilde's life was coming to its end, we went at once to see our doctor and reminded him of his earlier promise to administer euthanasia. I asked him how it was done. In the past, he told us, the patient drank a deadly potion, demonstrating for the last time the exercise of free will. But that is an uncertain method: Sometimes the patient throws up and survives in worse shape than before. More certain is the active method, where the doctor prepares two syringes. The first injection induces a deep coma; the second is a muscle relaxant that stops the heart. The whole process is over in a couple of minutes.

We still had a couple of weeks, perhaps a month or two, before things came to that. We informed our children, all adult now, our relatives and close friends, and then we settled down to wait.

There were three possible places for Mathilde's death: the hospital, a local hospice and at home, in her own bed. She chose the last option and began her preparations, taking off her wedding ring of more than 50 years and issuing firm instructions: I should be present when she died; if euthanasia were used, I must be at her bedside and our children nearby, in the house but not in the bedroom.

And contrary to what is common here, she wanted her body to be taken away before nightfall, not lying in state for several days for friends and relatives to pay their last respects, a custom Mathilde and I both disliked.

In all these matters I accepted her wishes without argument, as I was wont to do, for I knew how much she disliked tiresome explanations and discussions.

All her life, Mathilde had slept soundly, falling asleep like a contented child, and until her very last days she continued to do so. I slept at her side, not so soundly, with instructions about what to do should she die in her sleep (a vain hope): Close her eyes, prop up her chin ("Otherwise, my mouth will fall open and I shall look silly") and only then call the doctor.

Every morning, Mathilde would take her temperature. One day she ran a fever, and soon she became very ill indeed. First she contracted influenza but miraculously recovered; then there followed cystitis. She kept to her bed, and when another blood transfusion was due, she refused to go. She had given up. She no longer slept well and no longer wanted food or drink. The time had come to act.

The law lists four major conditions for euthanasia. It must be administered by a doctor; the patient must earnestly desire it, a resolve taken after due deliberation, and freely; there must be no prospect of recovery and, in the words of the law, the patient must be suffering unbearably. The attending physician must confirm that these conditions are met and write a report to this effect.

As a rule, the family doctor who has known the patient for years is the best judge of her condition and of the earnestness and independence of her request. But he must also consult another doctor, an outsider, for an independent assessment; that doctor must also put his views in writing. Afterward, both reports are submitted to a monitoring committee, which may ask for further explanation and can refer problematic cases to the Inspector of Health and the Public Prosecutor. But their annual reports show that the monitoring committees do this only very rarely - in 2010, at the rate of one in every 300 reported cases.

We called for the consulting doctor, who spent the better part of an hour with Mathilde. Afterward, he called our family doctor and said he was not sure she was suffering enough.

What is unbearable suffering? It is an impossible question. The monitoring committees have given up trying to define it and adopted the view that the patient's own judgment is decisive, provided the acting doctor is convinced of its earnestness and sincerity. For Mathilde, the prospect of being at the mercy of random infections while permanently dependent on blood transfusions was intolerable. We wrote a letter to this effect and heard no more of it.

Mathilde's death

On a Sunday morning not long afterward, we decided that the time had come. The logistics dictated a tight schedule. The doctor had to order the drugs, which meant a day's delay. On Tuesday, he would be available at the earliest in the afternoon, after his morning rounds. Afterward, we would have to wait for a visit from the coroner, since Mathilde would have died an unnatural death, and only after that could the undertaker take the body away.

We set the date for Tuesday at 3 p.m. Our children assembled in the sitting room and I was in the bedroom, with the doctor and a nurse. Mathilde had had a bad night, distraught and unable to sleep, and the doctor had come to give her morphine.

But now she was awake and fully conscious of her condition. To the nurse she said, "I am ready" and to me, "I am not afraid." I sat on one side of the bed and took her hand, and the doctor, at the other side, gave her the first injection.

She immediately fell asleep, snoring loudly. The doctor gave her a second injection, and the snoring stopped. She had died. It was all over in a couple of minutes.

What about emotions? Was there no grief, no anguish, was it all a matter of procedures and logistics?

Oh, yes, I felt plenty of grief in those terrible weeks. I had loved my wife more than anything else in the world, day by day, for over 50 years, and to know that she would shortly die was breaking my heart. But at the supreme moment, did our eyes meet in a last loving look? Were we united by a sense of extraordinary belonging and togetherness?

Nothing of the kind. By this time Mathilde was very ill and running a fever. Events demanded her utmost concentration, and quite understandably she had no time for me. And I, who had been crying for weeks, who had burst into tears at my appointment with the dentist when that kind man asked me in all innocence how I was, at this ultimate moment I felt nothing beyond the constant numbing grief of the last weeks.

The aftermath

I saw the doctor out, and one of our daughters went to dress her mother as she had wanted.

Then my children left, the nurse withdrew and I sat alone in the living room. The coroner, who had been alerted by the doctor, called to say that he was held up in traffic. When he arrived he stomped up the stairs and down again, and gave me a sheaf of legal papers. "Do not read them," he said. "Just hand them to the undertaker." I called the undertaker and told him we were ready.

And then, as I sat there by myself, all the formalities completed, I began to wonder whether I was right in not taking a last look at my wife in death. I reflected that many people derive comfort and solace from the practice, and I also recalled a passage from the memoirs of some British author who had also lost his wife in old age and in illness, like me. When he went to view her body, he reported that she had in death quite miraculously regained the radiance of her youth.

Three times I went upstairs to take a look. Mathilde was lying there peacefully, quite cold, even colder than the room, so it seemed. She looked no younger than she was when she died. Again I felt no particular emotion. The British author must have been a fool.

It was already dark when the undertaker's men arrived. It did not take them long to take Mathilde away.

The day was over, and all her wishes had been fulfilled.

Cramer is a retired professor of econometrics who lives in Amsterdam. He occasionally writes memoirs, short stories and opinion pieces in Dutch.

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Euthanasia was the right decision for my wife

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I was living in comfortable retirement with my wife, Mathilde, when, at the age of 71, she received a diagnosis of Waldenstrom's disease. The chief danger of this rare cancer of the bone marrow is that it impedes and eventually destroys the production of vital components of the blood supply.

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arguments and counterarguments for PAS

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Euthanasia: Right to life vs right to die

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Anti-Euthanasia

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Against the will of God

Religious people don't argue that we can't kill ourselves, or get others to do it. They know that we can do it because God has given us free will. Their argument is that it would be wrong for us to do so.

They believe that every human being is the creation of God, and that this imposes certain limits on us. Our lives are not only our lives for us to do with as we see fit.

To kill oneself, or to get someone else to do it for us, is to deny God, and to deny God's rights over our lives and his right to choose the length of our lives and the way our lives end.

The value of suffering

Religious people sometimes argue against euthanasia because they see positive value in suffering.

The religious attitude to suffering

Most religions would say something like this:

The nature of suffering

Christianity teaches that suffering can have a place in God's plan, in that it allows the sufferer to share in Christ's agony and his redeeming sacrifice. They believe that Christ will be present to share in the suffering of the believer.

Pope John Paul II wrote that "It is suffering, more than anything else, which clears the way for the grace which transforms human souls."

However while the churches acknowledge that some Christians will want to accept some suffering for this reason, most Christians are not so heroic.

So there is nothing wrong in trying to relieve someone's suffering. In fact, Christians believe that it is a good to do so, as long as one does not intentionally cause death.

Dying is good for us

Some people think that dying is just one of the tests that God sets for human beings, and that the way we react to it shows the sort of person we are, and how deep our faith and trust in God is.

Others, while acknowledging that a loving God doesn't set his creations such a horrible test, say that the process of dying is the ultimate opportunity for human beings to develop their souls.

When people are dying they may be able, more than at any time in their life, to concentrate on the important things in life, and to set aside the present-day 'consumer culture', and their own ego and desire to control the world. Curtailing the process of dying would deny them this opportunity.

Eastern religions

Several Eastern religions believe that we live many lives and the quality of each life is set by the way we lived our previous lives.

Those who believe this think that suffering is part of the moral force of the universe, and that by cutting it short a person interferes with their progress towards ultimate liberation.

A non-religious view

Some non-religious people also believe that suffering has value. They think it provides an opportunity to grow in wisdom, character, and compassion.

Suffering is something which draws upon all the resources of a human being and enables them to reach the highest and noblest points of what they really are.

Suffering allows a person to be a good example to others by showing how to behave when things are bad.

M Scott Peck, author of The Road Less Travelled, has written that in a few weeks at the end of life, with pain properly controlled a person might learn

The nature of suffering

It isn't easy to define suffering - most of us can decide when we are suffering but what is suffering for one person may not be suffering for another.

It's also impossible to measure suffering in any useful way, and it's particularly hard to come up with any objective idea of what constitutes unbearable suffering, since each individual will react to the same physical and mental conditions in a different way.

The slippery slope

Many people worry that if voluntary euthanasia were to become legal, it would not be long before involuntary euthanasia would start to happen.

This is called the slippery slope argument. In general form it says that if we allow something relatively harmless today, we may start a trend that results in something currently unthinkable becoming accepted.

Those who oppose this argument say that properly drafted legislation can draw a firm barrier across the slippery slope.

Various forms of the slippery slope argument

If we change the law and accept voluntary euthanasia, we will not be able to keep it under control.

Proponents of euthanasia say: Euthanasia would never be legalised without proper regulation and control mechanisms in place

Doctors may soon start killing people without bothering with their permission.

Proponents say: There is a huge difference between killing people who ask for death under appropriate circumstances, and killing people without their permission

Very few people are so lacking in moral understanding that they would ignore this distinction

Very few people are so lacking in intellect that they can't make the distinction above

Any doctor who would ignore this distinction probably wouldn't worry about the law anyway

Health care costs will lead to doctors killing patients to save money or free up beds:

Proponents say: The main reason some doctors support voluntary euthanasia is because they believe that they should respect their patients' right to be treated as autonomous human beings

That is, when doctors are in favour of euthanasia it's because they want to respect the wishes of their patients

So doctors are unlikely to kill people without their permission because that contradicts the whole motivation for allowing voluntary euthanasia

But cost-conscious doctors are more likely to honour their patients' requests for death

A 1998 study found that doctors who are cost-conscious and 'practice resource-conserving medicine' are significantly more likely to write a lethal prescription for terminally-ill patients [Arch. Intern. Med., 5/11/98, p. 974]

This suggests that medical costs do influence doctors' opinions in this area of medical ethics

The Nazis engaged in massive programmes of involuntary euthanasia, so we shouldn't place our trust in the good moral sense of doctors.

Proponents say: The Nazis are not a useful moral example, because their actions are almost universally regarded as both criminal and morally wrong

The Nazis embarked on invountary euthanasia as a deliberate political act - they didn't slip into it from voluntary euthanasia (although at first they did pretend it was for the benefit of the patient)

What the Nazis did wasn't euthanasia by even the widest definition, it was the use of murder to get rid of people they disapproved of

The universal horror at Nazi euthanasia demonstrates that almost everyone can make the distinction between voluntary and involuntary euthanasia

The example of the Nazis has made people more sensitive to the dangers of involuntary euthanasia

Allowing voluntary euthanasia makes it easier to commit murder, since the perpetrators can disguise it as active voluntary euthanasia.

Proponents say: The law is able to deal with the possibility of self-defence or suicide being used as disguises for murder. It will thus be able to deal with this case equally well

To dress murder up as euthanasia will involve medical co-operation. The need for a conspiracy will make it an unattractive option

Patient's best interests

A serious problem for supporters of euthanasia are the number of cases in which a patient may ask for euthanasia, or feel obliged to ask for it, when it isn't in their best interest. Some examples are listed below:

the diagnosis is wrong and the patient is not terminally ill

the prognosis (the doctor's prediction as to how the disease will progress) is wrong and the patient is not going to die soon

the patient is getting bad medical care and their suffering could be relieved by other means

the doctor is unaware of all the non-fatal options that could be offered to the patient

the patient's request for euthanasia is actually a 'cry for help', implying that life is not worth living now but could be worth living if various symptoms or fears were managed

the patient is depressed and so believes things are much worse than they are

the patient is confused and unable to make sensible judgements

the patient has an unrealistic fear of the pain and suffering that lies ahead

the patient is feeling vulnerable

the patient feels that they are a worthless burden on others

the patient feels that their sickness is causing unbearable anguish to their family

the patient is under pressure from other people to feel that they are a burden

the patient is under pressure because of a shortage of resources to care for them

the patient requests euthanasia because of a passing phase of their disease, but is likely to feel much better in a while

Supporters of euthanasia say these are good reasons to make sure the euthanasia process will not be rushed, and agree that a well-designed system for euthanasia will have to take all these points into account. They say that most of these problems can be identified by assessing the patient properly, and, if necessary, the system should discriminate against the opinions of people who are particularly vulnerable.

Chochinov and colleagues found that fleeting or occasional thoughts of a desire for death were common in a study of people who were terminally ill, but few patients expressed a genuine desire for death. ( Chochinov HM, Tataryn D, Clinch JJ, Dudgeon D. Will to live in the terminally ill. Lancet 1999; 354: 816-819)

They also found that the will to live fluctuates substantially in dying patients, particularly in relation to depression, anxiety, shortness of breath, and their sense of wellbeing.

Other people have rights too

Euthanasia is usually viewed from the viewpoint of the person who wants to die, but it affects other people too, and their rights should be considered.

family and friends

medical and other carers

other people in a similar situation who may feel pressured by the decision of this patient

society in general

Proper palliative care

Palliative care is physical, emotional and spiritual care for a dying person when cure is not possible. It includes compassion and support for family and friends.

Competent palliative care may well be enough to prevent a person feeling any need to contemplate euthanasia.

The key to successful palliative care is to treat the patient as a person, not as a set of symptoms, or medical problems.

The World Health Organisation states that palliative care affirms life and regards dying as a normal process; it neither hastens nor postpones death; it provides relief from pain and suffering; it integrates the psychological and spiritual aspects of the patient.

Making things better for patient, family and friends

The patient's family and friends will need care too. Palliative care aims to enhance the quality of life for the family as well as the patient.

Effective palliative care gives the patient and their loved ones a chance to spend quality time together, with as much distress removed as possible. They can (if they want to) use this time to bring any unfinished business in their lives to a proper closure and to say their last goodbyes.

Palliative care should aim to make it easier and more attractive for family and friends to visit the dying person. A survey (USA 2001) showed that terminally ill patients actually spent the vast majority of their time on their own, with few visits from medical personnel or family members.

Spiritual care

Spiritual care may be important even for non-religious people. Spiritual care should be interpreted in a very wide sense, since patients and families facing death often want to search for the meaning of their lives in their own way.

Palliative care and euthanasia

Good palliative care is the alternative to euthanasia. If it was available to every patient, it would certainly reduce the desire for death to be brought about sooner.

But providing palliative care can be very hard work, both physically and psychologically. Ending a patient's life by injection is quicker and easier and cheaper. This may tempt people away from palliative care.

Legalising euthanasia may reduce the availability of palliative care

Some fear that the introduction of euthanasia will reduce the availability of palliative care in the community, because health systems will want to choose the most cost effective ways of dealing with dying patients.

Medical decision-makers already face difficult moral dilemmas in choosing between competing demands for their limited funds. So making euthanasia easier could exacerbate the slippery slope, pushing people towards euthanasia who may not otherwise choose it.

When palliative care is not enough

Palliative care will not always be an adequate solution:

Pain: Some doctors estimate that about 5% of patients don't have their pain properly relieved during the terminal phase of their illness, despite good palliative and hospice care

Dependency: Some patients may prefer death to dependency, because they hate relying on other people for all their bodily functions, and the consequent loss of privacy and dignity

Lack of home care: Other patients will not wish to have palliative care if that means that they have to die in a hospital and not at home

Loss of alertness: Some people would prefer to die while they are fully alert and and able to say goodbye to their family; they fear that palliative care would involve a level of pain-killing drugs that would leave them semi-anaesthetised

Not in the final stages: Other people are grateful for palliative care to a certain point in their disease, but after that would prefer to die rather than live in a state of helplessness and distress, regardless of what is available in terms of pain-killing and comfort.

Pressure on the vulnerable

This is another of those arguments that says that euthanasia should not be allowed because it will be abused.

The fear is that if euthanasia is allowed, vulnerable people will be put under pressure to end their lives. It would be difficult, and possibly impossible, to stop people using persuasion or coercion to get people to request euthanasia when they don't really want it.

The pressure of feeling a burden

People who are ill and dependent can often feel worthless and an undue burden on those who love and care for them. They may actually be a burden, but those who love them may be happy to bear that burden.

Nonetheless, if euthanasia is available, the sick person may pressure themselves into asking for euthanasia.

Pressure from family and others

Family or others involved with the sick person may regard them as a burden that they don't wish to carry, and may put pressure (which may be very subtle) on the sick person to ask for euthanasia.

Increasing numbers of examples of the abuse or neglect of elderly people by their families makes this an important issue to consider.

Financial pressure

The last few months of a patient's life are often the most expensive in terms of medical and other care. Shortening this period through euthanasia could be seen as a way of relieving pressure on scarce medical resources, or family finances.

It's worth noting that cost of the lethal medication required for euthanasia is less than £50, which is much cheaper than continuing treatment for many medical conditions.

Some people argue that refusing patients drugs because they are too expensive is a form of euthanasia, and that while this produces public anger at present, legal euthanasia provides a less obvious solution to drug costs.

If there was 'ageism' in health services, and certain types of care were denied to those over a certain age, euthanasia could be seen as a logical extension of this practice.

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Religious people don't argue that we can't kill ourselves, or get others to do it. They know that we can do it because God has given us free will. Their argument is that it would be wrong for us to do so.

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Arguments from both sides and stats

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Main arguments and history of euthanasia

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Legalizing euthanasia or assisted suicide: the illusion of safeguards and controls

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Euthanasia or assisted suicide—and sometimes both—have been legalized in a small number of countries and states. In all jurisdictions, laws and safeguards were put in place to prevent abuse and misuse of these practices. Prevention measures…

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Overview of Euthanasia Laws in all states and requirements

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Pro-Euthanasia

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BBC - Ethics - Euthanasia: Pro-euthanasia arguments

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This page sets out the arguments in favour of allowing euthanasia in certain cases. Should we accept that euthanasia happens and try to regulate it safely? Do people have the right to arrange their own deaths?

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Positions

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Quick facts and opinions

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BBC - Ethics - Euthanasia: Regulation of euthanasia

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Examining what an official system for euthanasia might look like and how the process would be regulated, which would be difficult to achieve - or, some people believe, impossible.

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Christian view on euthanasia and supporting bible verses

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A brief history and details about arguments and cases

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Journal of Ethics | American Medical Association

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The 1997 US Supreme Court ruling regarding physician-assisted suicide is often misrepresented or misunderstood. The question before the court was specific: Are state laws that criminalize physician-assisted suicide unconstitutional? The high court ruled that such laws were not unconstitutional. That ruling, however, did not make physician-assisted suicide a crime throughout the land. It declared, rather, that legalizing or criminalizing physician-assisted suicide (P-AS) was a matter of states' rights; that is, a matter for each state to decide for itself.

Three years prior to the high court's decision, Oregon voters had approved a referendum legalizing P-AS by a slim margin of 51 percent. Following the Supreme Court ruling, Oregon offered the question to voters again, in November 1997, this time receiving a 60 percent majority in favor of legalizing the practice.

Four states besides Oregon-Michigan, Washington, California, and Maine-have asked voters about P-AS, and voters in all 4 have turned it down. On the Maine referendum ballot in 2002, the question asked succinctly and in plain English: "Should a terminally ill adult who is of sound mind be allowed to ask for and receive a doctor's help to die?" Maine voters said "no" (meekly) by a vote of 51.5 percent to 48.5 percent.

Forty-six states stand opposed to Oregon, formally criminalizing P-AS. Forty of them (most recently Ohio in November 2002) have passed statutes that prohibit the practice, and 6 prohibit it by common law. Three states-North Carolina, Utah, and Wyoming have neither criminalized nor legalized physician-assisted suicide.

Those who oppose the practice advance 2 main arguments: (1) legalizing physician-assisted suicide will cause pressure on terminal patients who fear their illness is burdensome--physically, emotionally, or financially--to their families or caretakers and, (2) as Maine Medical Society's executive VP Gordon Smith put it, "physician-assisted suicide goes against 2,000 years of medical ethics." ¹ Smith has a point. The current version of the AMA's 155-year old Code of Medical Ethics prohibits physician-assisted suicide in the same strong language it uses in prohibiting physician involvement in euthanasia: "Physician-assisted suicide is fundamentally incompatible with the physician's role as healer, would be difficult or impossible to control, and would pose serious societal risks." ²

In an attempt to override Oregon's Death with Dignity Act, the statute that regulates the legal use of P-AS, US Attorney General John Ashcroft issued a directive in November 2001 entitled "Dispensing of Controlled Substances to Assist Suicide." The directive asserts that assisted suicide is not "a legitimate medical purpose" for potentially lethal drugs classified under the Controlled Substances Act. Under the directive, doctors who use these drugs to assist suicide are subject to having their federal narcotics licenses suspended or revoked. The directive caused much consternation, even among physicians who do not support and would not participate in P-AS, because it puts at risk all doctors who prescribe narcotics for management of intractable, end-of-life pain. A large part of the medical community expressed the fear that the directive would undo years of work spent in overcoming fears of addiction and securing adequate pain relief for patients. In April of 2002, US District Judge Robert Jones put a permanent restraining order on the Ashcroft Directive, explaining that Ashcroft had "overstepped the authority of the federal Controlled Substances Act when he declared that physician-assisted suicide was not a 'legitimate medical purpose'." ³ The US Attorney General's Office has said it will appeal Judge Jones's ruling.

Law versus Professional Ethics

That a state can legalize physician-assisted suicide, as Oregon has done, highlights the difference between what is legal and what is ethical; what the state allows residents to do and what members of a given profession, in this case medicine, believe they ought to do. Though a state may legalize physician-assisted suicide-or abortion, or capital punishment, for that matter-it cannot force doctors who oppose the practice on grounds of professional ethics or personal beliefs to participate. There is a difference between what voters want and what constitutes sound medical practice, according to Gregory Hamilton, MD, co-founder and past president of Physicians for Compassionate Care, a group that opposes P-AS. "It's up to the medical profession-not Judge Jones or the voters of Oregon-to decide what's a legitimate medical practice," Hamilton said. ³

Why Some Physicians Help

Most terminally ill patients who wish to commit suicide want to do so by medical means, nonviolently, out of respect for themselves and others. Yet medical suicide is not easy to accomplish; dosage and timing of drug administration matter critically, especially if the drug is taken orally, and failed attempts can cause greater trauma than death itself for the patient and caregivers. Patients may beg caregivers to complete their failed attempt at dying. These circumstances and possible consequences convince some physicians that helping a patient who is determined to end his or her life prevents a greater harm than it causes. Moreover, some believe that ending, at a patient's request, the physical pain and mental anguish from which that patient will not recover does not violate the spirit or goals of medical ethics.

What Ethical Choices Does a Physician Have?

If a state does legalize physician-assisted suicide, what choices do physicians in that state face? Must they opt either to (1) refuse aid to patients determined upon killing themselves, thus driving those patients to seek help from other, possibly unknown, physicians or inexperienced caregivers or (2) violate their profession's principal code of ethics?

There are many services physicians can provide a patient who asks for assistance in dying without violating professional ethics or personal beliefs. First, they must confront the task of presenting the most accurate prognosis. This is a difficult but critical task that only the physician can perform. It demands skill, experience, and courage. In Death Foretold, physician Nicholas Christakis emphasizes that the lack of a prognosis, or an inaccurate one, can lead patients to make bad choices near the end of life. ⁴ Next, physicians must carefully describe all possible treatment and palliative care optionsto the patient and discuss what he or she can expect as consequences of each of those care options, as well as the consequences of accepting no treatment or care. Physicians can also play a role in referring terminally ill patients to others--psychiatrists, hospice workers, clergy--who can evaluate their mental status and help them consider end-of-life decisions. Meanwhile, however, physicians should maintain their relationship with the patient, no matter what course the patient finally chooses, short of participating in suicide, if that is the patient's ultimate choice. Withdrawing and withholding treatment, including ventilator treatment, CPR, and even nutrition and hydration, at the express request of the patient or patient's surrogate are all within the bounds of professional practice, according the Code of Medical Ethics. ⁵

In 1997, the University of Pennsylvania's Center for Bioethics commenced a project called Finding Common Ground to explore, among other topics, how physicians should respond to requests for assistance in dying. ⁶ One report from the project examined whether physicians were the only professionals, or even the best professionals, to aid in helping terminally ill patients end their lives. ⁷ The report concluded that doctors played a necessary but not a sufficient role. Physicians are best equipped among health care professionals to determine the patient's diagnosis, prognosis, and full range of treatment options. These activities in themselves, of course, do not violate the AMA Code of Medical Ethics that prohibits physician assistance with suicide: they are professional services rendered to all patients. The remaining activities that, according to the report, patient suicide should entail are: preparing the person for dying, providing the means, providing support during administration of the medications and while the patient is dying, managing complications, reporting the assisted suicide, and coordinating the overall process. These need not be carried out by physicians. Even prescribing of the drug could fall within the professional purview of nurse practitioners and physician assistants. In addition to health care professionals, clergy, social workers, and other counselors could participate. In this case, each of these health care professions would face the ethics question that physicians now confront and on which the AMA has taken a stand.

The Advocacy Role of Physicians

Many believe that when law and professional ethics come into conflict physicians have obligations beyond their one-on-one covenant with patients. Alex Capron and Eliot Friedson, for example, have written that physicians have a social and political duty to create an environment that encourages the ethical practice of medicine. ⁸ On this view, physicians should support and campaign for regulations that ensure humane care for the terminally ill and reimbursement for the costs of proper end-of-life care. Such provisions will reduce patients' concerns that their end-of-life care is overwhelmingly burdensome to others.

Physicians should also consider how best to care for and respond to those competent, terminally ill individuals in intractable pain who wish to die without spending days or weeks paralyzed from pain-killing medication or comatose and who desire help from medical professionals in doing so. The number of individuals in this category should remain few, but there will always be some. It is desirable to have guidelines and practices in place that allow health care professionals to respond legally and ethically. The absence of such guidelines, promotes unethical behavior among those who are genuinely trying to do what they deem best for their patients.

Citation

Virtual Mentor. 2003;5(1):21-25.

DOI
10.1001/virtualmentor.2003.5.1.pfor1-0301
The viewpoints expressed in this article are those of the author(s) and do not necessarily reflect the views and policies of the AMA.

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Physician-Assisted Suicide: The Law and Professional Ethics

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The 1997 US Supreme Court ruling regarding physician-assisted suicide is often misrepresented or misunderstood. The question before the court was specific: Are state laws that criminalize physician-assisted suicide unconstitutional? The high court ruled that such laws were not unconstitutional. That ruling, however, did not make physician-assisted suicide a crime throughout the land.

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Many personal stories and sayings from people suffering

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Telling personal stories can be extremely powerful. Each one is a painful reminder that our current law is broken and needs to change.

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Overview from Infobase

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Arguments against PAS

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By the time of his death in 2011, Dr. Jack Kevorkian was said to have assisted in the suicides of at least 130 patients. In part because of his advocacy, physician-assisted suicide became a heated topic of discussion in the 1990s. 1

Five states-Oregon, Washington, Vermont, Colorado, and California-and the District of Columbia now have Death With Dignity acts that allow adults with a prognosis of no more than 6 months to live to choose to end their lives. Montana allows an "end-of-life option" via a ruling of the state's supreme court in 2009. ² The intent of such laws is to help terminally ill patients avoid undue pain and suffering and allow them more autonomy in decisions concerning their end-of-life care. Participating individuals must be mentally competent, able to voluntarily request and obtain the necessary prescription, and self-administer the medication. ³ Most participants are younger than 65, have received a diagnosis of terminal cancer, and are in hospice care. ⁴ All health care providers involved in the process are legally protected from charges of assisted suicide, homicide, and elder abuse. ²

Death with dignity is a controversial issue. Thirty-seven states have laws expressly prohibiting physician-assisted suicide, ⁵ and physician opponents say that actively participating in the death of a patient violates the Hippocratic Oath, which instructs doctors to "do no harm." Health care systems with religious affiliations also oppose death with dignity, claiming that death is a "sacred part of life's journey" that should neither be hastened nor delayed. ² Furthermore, there is concern that such laws open the door to potential abuse. ⁶ The determination of a patient's prognosis can be arbitrary, and physicians are not held accountable for the life-ending drugs that they prescribe. This lack of accountability may lead to patients being pressured by physicians or family members into committing suicide or using physician-assisted suicide to avoid exorbitant medical bills. 6 In response, because an individual's decision to die with dignity is viewed as strictly voluntary, health care providers, hospitals, and physician groups may opt out without the risk of penalty. ²

Advocates of death with dignity argue that the practice is uncommon; a physician may encounter the situation only once or twice in a career. Further, since the passage of the Oregon law in 1997, fewer than 2000 prescriptions for lethal drugs have been written in Oregon, and just 65% have been used. This is a pattern that is consistent year after year (FIGURE 1). ⁴ Moreover, choosing to die is not an instantaneous decision. For example, Oregon law requires patients to make 2 oral requests to their physician at least 15 days apart, followed by a written request signed in the presence of 2 witnesses. The attending physician must then confirm the patient's diagnosis and prognosis with a consulting physician. If either provider believes that the patient's judgment is impaired by a psychiatric or psychological disorder, then a referral for a psychological evaluation must be made. If all requirements are met, then the physician must inform the patient of all reasonable alternatives to death with dignity. If the patient confirms their decision, the medication must be dispensed directly to the patient by the physician or via a written prescription delivered to a pharmacist either by the physician or through the mail. The patient may rescind the request at any time. ³ Such conditions ensure that the physician's and the patient's judgments are neither hastened nor coerced.

Prescriptions for the high doses of oral barbiturates that are typically used in physician-assisted suicide may end up in the hands of a community pharmacist. ⁴ This raises important considerations for the pharmacist, including patient-counseling issues, legal requirements, moral and ethical concerns, and consequences for refusing to dispense the medication. The American Society of Health-System Pharmacists released a statement in 1999 regarding pharmacists' participation in death with dignity. The statement indicates that it is the duty of a pharmacist to provide patient-specific care and to respect the autonomy of the patient but that it also is the right of the pharmacist to choose not to participate in "morally, religiously, or ethically troubling therapies." 7

End-of-life care presents a great opportunity for pharmacists to exercise their expertise. Physicians and pharmacists must contemplate the implications of death with dignity laws on their personal beliefs and future practice to provide empathy, understanding, and the best possible care to their patients.

Source: Oregon Health Authority Public Health Division, Center for Health Statistics. February 2017.

Erin N. Deja is a fourth-year PharmD student at the University of Kentucky College of Pharmacy.

Joseph L. Fink III is a professor of pharmacy law and policy and the Kentucky Pharmacists Association Endowed Professor of Leadership at the University of Kentucky College of Pharmacy, Lexington. References

1. Davey M. Kevorkian speaks after his release from prison. The New York Times website. nytimes.com/2007/06/04/us/04kevorkian.html. Published June 4, 2007. Accessed June 6, 2017.

2. LeBlanc J, Struve A, Mendoza L, Levy M. Difficult choices for healthcare providers as California legalizes assisted suicide. Lexology website. lexology.com/library/detail.aspx?g=ad4f41bd-ce90-48da-bce2-345bc3fcfcfa. Published October 10, 2016. Accessed June 6, 2017.

3. Oregon Death with Dignity Act. Ore Stat §127.800.

4. Oregon Health Authority, Public Health Division, Center for Health Statistics. Oregon Death with Dignity Act. Data summary 2016. Oregon state website. public.health.oregon.gov/ProviderPartnerResources/EvaluationResearch/DeathwithDignityAct/Documents/year19.pdf. Published February 10, 2017. Accessed June 6, 2017.

5. Gray K. Bill legalizing assisted suicide gets new life in Lansing. Detroit Free Press website. freep.com/story/news/politics/2016/08/13/bill-legalizing-assisted-suicide-gets-new-life-lansing/88537468. Published August 13, 2016. Accessed June 6, 2017.

6. Judge refuses to suspend California's assisted death law. Modern Healthcare website. modernhealthcare.com/article/20160827/NEWS/160829934. Published August 27, 2016. Accessed June 6, 2017.

7. ASHP statement on pharmacist's decision-making on assisted suicide. Am J Health-System Pharm. 1999;56(16):1661-1664.

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By the time of his death in 2011, Dr. Jack Kevorkian was said to have assisted in the suicides of at least 130 patients. In part because of his advocacy, physician-assisted suicide became a heated topic of discussion in the 1990s.

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How regulations failed-personal stories

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Proponents of legalized assisted suicide always point to Oregon as a shining example of how assisted suicide should be practiced. They point to "safeguards" enacted in the law designed to protect patients. Here are some real life examples of abuse and exploitation of Oregon patients:
Kate Cheney
Kate Cheney, 85, had terminal cancer and told her doctor she wanted assisted suicide. However, he was concerned that she didn't meet the required criteria for mental competence because of dementia. So he declined to write the requested prescription and instead referred her to a psychiatrist as required by law. She was accompanied to the psychiatric consultation by her daughter. The psychiatrist found that Kate had a loss of short-term memory. It also appeared that her daughter had more interest in Cheney's assisted suicide than did the patient herself. The psychiatrist wrote in his report that while the assisted suicide seemed consistent with Kate's values, 'she does not seem to be explicitly pushing for this." He also determined that Kate did not have the "very high capacity required to weigh options about assisted suicide," and he declined to authorize the lethal prescription.

Kate seemed to accept the psychiatrist's verdict, but her daughter did not. Her daughter viewed the guidelines protecting her mother's life as obstacles, and in a press interview called the guidelines a "roadblock" to Kate's right to die and demanded that Kate's HMO, Kaiser Permanente, provide a second opinion. This was provided by a clinical psychologist (rather than an MD-psychiatrist) who also found Kate had memory problems. The psychologist also worried about familial pressure, writing that Kate's decision to die "may be influenced by her family's wishes." Still, despite these reservations, the psychologist determined that Kate was competent to choose death.

Sometime later, Kate went into a nursing home for a week so that her family could have some respite from care giving. After she returned home, she declared her desire to take the pills herself and approved the writing of the lethal prescription.
How safeguards failed Kate Cheney:

It is possible to circumvent safeguards by "shopping" for an agreeable professional if the patient or family disagrees with professional opinions.

By giving the interview, the patient's daughter unintentionally revealed that the law does not adequately protect patients with diminished capacity from family coercion.

Financial considerations may have influenced the HMO director to write the prescription.

Patrick Matheny
Patrick Matheny, 43, had Lou Gehrig's disease (ALS). For several months, he struggled with a decision to end his life using a lethal prescription. He would set arbitrary deadlines, then, when the time came, would set new deadlines. At first, it was to be after his 15-year-old son came to visit at Thanksgiving. Then it was to be when he could no longer dress and wash himself. As an article in the Oregonian put it, "Pat felt he would rather be dead than accept help to bathe and dress." But when the time came, he was able to handle having his mother and hospice nurses help him so he set new deadlines.

On March 10, 1999, Matheny tried to swallow the barbiturates mixed into a chocolate nutrition drink, sweetened with a boxful of sugar substitute. Reportedly, he experienced difficulty swallowing the concoction. The only person Matheny had asked to be with him in his trailer was his brother-in-law, Joe Hayes. Hayes told the Oregonian that he had to "help" Matheny to die, but would not say how. According to Hayes, it was too personal. "It doesn't go smoothly for everyone," Hayes explained. "For Pat it was a huge problem. It would have not worked without help," he added.
How safeguards failed Patrick Matheny:

Patients are required by law to self-administer the lethal drug to protect them from coercion and foul play.

Even though this violation of the law was reported in the newspapers, no investigation was done, sending the signal that the Oregon law can be violated with impunity.

Oregonian,10/27/99, 1/17/99, 3/17/99
Register-Guard, 3/16/99
Michael Freeland
Michael Freeland requested and received a lethal prescription from Dr. Peter Reagan, a suicide advocate, a few months after being diagnosed with lung cancer. Dr. Reagan offered to refill it when he outlived his six-month limit.

Over a year after receiving the first prescription, Freeland was admitted to a psychiatric treatment facility with depression and suicidal intent. He was treated and improved. His professional caregivers ensured that his 32 guns and all his ammunition were removed from his home before he was allowed to return, but they knowingly allowed him to keep his lethal prescription. His treating psychiatrist wrote a letter to the court the day after his discharge saying he was not competent and needed a guardian.

Freeland called Physicians for Compassionate Care. (He called them accidentally; he was actually trying to contact the suicide advocacy organization Compassion in Dying). Physicians for Compassionate Care volunteers helped him through his last several months of life, saw that his depression and his symptoms were treated aggressively, and assisted him in reconciling with his estranged daughter.

He died naturally and comfortably nearly two years after receiving his first lethal prescription. Before he died, he signed an authorization releasing his medical records for public review.
How safeguards failed Michael Freeland:

Freeland was given an incorrect prognosis - he was not within six months of dying.

The prescribing doctor offered a lethal prescription to a depressed patient.

Even after courts determined that Freeland was not competent and in need of a guardian, he was allowed to keep his lethal prescription.

Mrs. S.
Mrs. S. from Oregon had been struggling with a malignant lymphoma for three years. In spite of the best efforts of her several physicians, it had spread from her lymph nodes to her bones, brain and spinal cord. She had vigorous chemotherapy and radiation therapy. She had considerable pain, but this was kept under adequate control with medication. She was repeatedly discouraged, and this was helped somewhat by use of an antidepressant.

In a final visit with her primary physician, he gently confronted the fact that there was nothing more that could be done for the disease, though comfort measures could be continued. At the end of the visit, he said, "Well, I could write a prescription for an extra large amount of pain medication for you." She declined the offer and left the office. Mrs. S. and her husband were devastated. She kept saying, "He wants me to kill myself!" They interpreted his offer as saying "Your life is no longer worth living. You would be better off dead." Their longstanding good relationship with this seemingly caring physician was shattered by this new understanding of his values. Mrs. S. died comfortably at home several days later.
How safeguards failed Mrs. S.:

Such an offer by a physician is illegal under the Oregon law.
Clarietta Day
After passage of the Oregon law allowing physician-assisted suicide, but before it went into effect, Clarietta Day, age 78, had a severe stroke. She had told her longstanding physician, Dr. James Gallant (Corvallis, Ore.), that she did not want heroic measures and did not want to be kept alive on machines. Based on this understanding of the patient's wishes, Dr. Gallant (1) took her off life support, (2) gave her frequent large doses of painkillers, and (3) attempted to stop her cardiac pacemaker by placing a magnet over it. She continued to breathe. He then ordered an intravenous injection of a paralyzing drug and Mrs. Day died in 15 minutes. Dr. Gallant wrote on her death certificate that the cause of death was "stroke due to subarachnoid hemorrhage."

The Oregon Board of Medical Examiners investigated and called this active euthanasia, an action they felt was both unethical and illegal. They suspended his license to practice for 60 days. The district attorney decided not to file criminal charges.
How the unenforceable law failed Clarietta Day:

Dr. Gallant's lethal injection was clearly illegal. Was he motivated by pending new legislation that would allow doctors to hasten death?

Would this incident have been reported in the official physician-assisted suicide statistics had it happened after the law went into effect?

David Pruitt
David Pruitt, a man from Oregon with lung cancer, obtained from a physician the standard lethal prescription, and when he felt it was time, he took the entire amount. He went to sleep for 65 hours and woke up saying "What the hell happened? Why am I not dead?" He was so unnerved by the experience that he didn't want to go through it again. He died naturally about two weeks later.
Facts learned from David Pruitt:

While Mr. Pruitt's case is the first to come to public attention, repeated data from the Netherlands shows that 18-25% of Dutch people who take the same dose of the same drug as is used in Oregon do not die. They are then given a lethal injection by their doctor which is legal in the Netherlands.

The Oregon law does not allow lethal injection, and it is not known what happens to those who do not die. Deaths from physician-assisted suicide are not investigated in Oregon, and the state government says they have no way of knowing how often assisted suicide happens outside the framework of the law.

Helen X

Soon after the Oregon law allowing a physician to write a lethal prescription for a patient went into effect, Helen asked her physician for one. She had a history of breast cancer and was enrolled in hospice. She had been using a wheelchair for two weeks and had some shortness of breath for which she used oxygen. However, she had no pain and she was still doing aerobic exercises regularly. Her physician declined. Helen saw a second physician, and he too declined because he felt she was depressed. Her husband called Compassion in Dying (a group that supports assisted suicide) and they found a willing physician who wrote the prescription, though he admitted he was shaken by Helen's eagerness to die.
How safeguards failed Helen X:

Physician refusal to write a lethal prescription because the requesting patient does not meet the legal criteria need not deter a patient who is eager to die. All Helen had to do was keep asking until she found someone willing.
Barbara Houck
In January of 1999, Barbara Houck, age 71, was diagnosed with Amytropic Lateral Sclerosis, a progressive neurological disease. Almost immediately, she called Peter Rasmussen (not a neurologist, but an oncologist and a supporter of physician-assisted suicide) requesting a lethal prescription. He declined because he felt she had more than six months to live. She saw him again in March and he wrote the prescription. He was present April 10, the day she chose to die. He emptied the 90 capsules into a bowl of chocolate pudding and her two sons spooned it into her mouth. Dr. Rasmussen stayed for two hours. She died 12 hours after ingestion of the lethal drug.
How safeguards failed Barbara Houck:

It is very unusual for an oncologist to evaluate and make a prognosis for a patient with an uncommon neurological disease.

The legally required prognosis of "less than six months to live," required by the law, is in doubt.

The law requires the patient to self-administer the lethal drug. Houck received significant help from her physician and her sons.

Patient of Dr. Charles Bentz
Dr. Charles Bentz, an internist in Portland, Oregon, diagnosed a malignant melanoma in a 76-year-old man who had been under his care for over ten years. Unfortunately, the cancer had already spread to his shoulder at the time of diagnosis, so it was not curable. Dr. Bentz referred this active man to both radiation oncology and medical oncology, using two methods to slow the cancer and prolong the man's life.

When the patient finished the radiation therapy, the radiation oncologist informed Dr. Bentz that the patient was depressed due to his diminished physical stamina. At almost the same time, he finished his chemotherapy and asked his medical oncologist for a prescription so he could take his own life by suicide. The medical oncologist called Dr. Bentz, asking him to act as the required second physician to confirm the diagnosis and prognosis before he wrote the prescription, saying secobarbital "works very well" and indicating he had used it many times. Dr. Bentz responded that he could not do this; the man had a documented depression and needed therapy for this. The oncologist then found another physician to render the required "second opinion" and did not refer the man back to his primary physician. Two weeks later the patient was dead from a lethal prescription.

Dr. Bentz obtained permission from the man's family and obtained a copy of the death certificate which falsely said death was from malignant melanoma.
How safeguards failed the patient of Dr. Bentz:

The patient's well-documented depression was not evaluated by a mental health specialist, nor was it treated.

The patient's primary physician was excluded from helping him with his end-of-life concerns.

The patient's oncologist falsified a public document by lying about the cause of death.

Summary of patient stories courtesy of the Vermont Alliance for Ethical Health Care, www.vaeh.org.

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Proponents of legalized assisted suicide always point to Oregon as a shining example of how assisted suicide should be practiced. They point to "safeguards" enacted in the law designed to protect patients. Here are some real life examples of abuse and exploitation of Oregon patients: Kate Cheney Kate Cheney, 85, had terminal cancer and told her doctor she wanted assisted suicide.

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Arguments against PAS

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The American Medical Association, and the entire profession of medicine in the U.S., stand at a crucial ethical crossroads. For two years the AMA has been considering the question of physician-assisted suicide (PAS): shall physician assistance with patient suicide now be considered permissible, or shall physicians hold fast to the ethic that a physician's duty is to "to cure sometimes, to relieve often, and to comfort always," but never to kill?

In 2016, AMA delegates from Oregon brought a resolution to the AMA House of Delegates (HOD), its policy-making body, to request that the AMA consider dropping its longstanding opposition to physician-assisted suicide in favor of a position of neutrality. The AMA's ethical body, the Council on Ethical and Judicial Affairs (CEJA), spent 2 years of intensive study of the practice of PAS, gathering information from physicians, ethicists, U.S. states and foreign countries on the practice and implications of PAS, in an exhaustive, open and transparent process. In June of 2018 CEJA offered its report and recommendations to the AMA HOD for its consideration.

The CEJA report included a review of the European experience where PAS began with terminal patients, then progressed to healthy people with depression, then people "tired of life," people unhappy after sex change operations, and so on. In Europe and now, frighteningly, in Canada, PAS rapidly progressed to active euthanasia (direct physician killing of patients). The CEJA report concluded that the AMA ethical position on PAS should not be changed, that PAS remains "fundamentally incompatible with the physician's role as healer, would be difficult or impossible to control, and would pose serious societal risks."

While recognizing the danger of PAS and the wisdom of keeping its ethical guidance unchanged, CEJA also recognized that physicians advocating for PAS do so from a conscientious belief that it is appropriate, therefore the CEJA report also referenced AMA's position on conscience:

"Preserving opportunity for physicians to act (or to refrain from acting) in accordance with the dictates of conscience in their professional practice is important for preserving the integrity of the medical profession as well as the integrity of the individual physician, on which patients and the public rely. Thus physicians should have considerable latitude to practice in accord with well-considered, deeply held beliefs that are central to their self-identities."

PAS advocates were dissatisfied by the balanced recommendations offered by the CEJA report, instead insisting that the report be reconsidered until CEJA agree to changing AMA medical ethics. But, increasingly, the AMA delegates are moving towards a rejection of the idea of PAS. At the AMA meeting in June of 2018, the HOD declined to endorse the CEJA report, referring it back for further study by a margin of 10% of votes cast. However, at the recent November 2018 AMA meeting, the CEJA report was nearly accepted, missing by only 3%. As the delegates hear the logical flaws in the arguments used to push PAS, these arguments are losing appeal. Among the pro-PAS arguments debunked by physicians defending the 2,400-year-old Hippocratic tradition that physicians "give no deadly medicine" are the argument of neutrality and the argument that patient autonomy should determine medical ethics.

PAS advocates claim that the AMA must adopt neutrality because there are divided views on PAS. Eminent bioethicist and physician from Georgetown University, Dr. Daniel Sulmasy, decisively debunked the neutrality argument in his recent article in the Journal of General Internal Medicine:

"Neutrality is not neutral. To change from opposition to neutrality represents a substantive shift in a professional, ethical, and political position, declaring a policy no longer morally unacceptable; the political effect is to give it a green light.

"Some might argue that neutrality is necessary because there are jurisdictions in which members of medical organizations can prescribe PAS legally. But exceedingly few physicians engage in the practice even in jurisdictions where it is legal, and the fact that some members do so does not require any professional body to be 'neutral' with respect to that practice. As a logical counter-example... to the thesis that professional neutrality is required if a medical practice is legal, consider the fact that physician participation in capital punishment is legal in 30 states. This fact does not affect the ethical opposition that the profession takes, nor has organized medicine felt compelled to give instructions on how to execute prisoners well for those few members who do this."

Patient autonomy has been suggested as a justification for PAS. However, no physician would amputate a patient's healthy limb just because the patient wishes it done. Physicians don't give certain drugs or perform certain procedures that are absolutely contraindicated, even if the patient requests it, because physicians are required to use their knowledge to protect the patient. Patient autonomy is important, but never the only factor in a decision, and is never used to determine overarching professional ethics.

PAS advocates also want to "hide the ball" on PAS, obscuring the fact that it is suicide by giving it pleasant but unclear names like "physician aid in dying." CEJA rightly rejected this, noting that "the term physician-assisted suicide describes the practice with greatest precision. More importantly, it clearly distinguishes the practice from euthanasia. The terms "aid in dying" or "death with dignity" could be used to describe either euthanasia or palliative/hospice care at the end of life and this degree of ambiguity is unacceptable for providing ethical guidance."

The AMA is moving towards a reaffirmation of its historic and vital policy opposing PAS, which will best guide physicians and protect patients.
Shane E. Macaulay, MD, is a radiologist with Center for Diagnostic Imaging in Washington state, and twice selected as one of Seattle's Top Doctors. He is an AMA Alternate Delegate from Washington state.

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Physician-Assisted Suicide: The AMA's Latest Quandary

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The American Medical Association, and the entire profession of medicine in the U.S., stand at a crucial ethical crossroads. For two years the AMA has been considering the question of physician-assisted suicide (PAS): shall physician assistance with patient suicide now be considered permissible, or shall physicians hold fast to the ethic that a physician's duty is to "to cure sometimes, to relieve often, and to comfort always," but never to kill?

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How regulations failed-personal stories

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Proponents of legalized assisted suicide always point to Oregon as a shining example of how assisted suicide should be practiced. They point to "safeguards" enacted in the law designed to protect patients. Here are some real life examples of abuse and exploitation of Oregon patients:
Kate Cheney
Kate Cheney, 85, had terminal cancer and told her doctor she wanted assisted suicide. However, he was concerned that she didn't meet the required criteria for mental competence because of dementia. So he declined to write the requested prescription and instead referred her to a psychiatrist as required by law. She was accompanied to the psychiatric consultation by her daughter. The psychiatrist found that Kate had a loss of short-term memory. It also appeared that her daughter had more interest in Cheney's assisted suicide than did the patient herself. The psychiatrist wrote in his report that while the assisted suicide seemed consistent with Kate's values, 'she does not seem to be explicitly pushing for this." He also determined that Kate did not have the "very high capacity required to weigh options about assisted suicide," and he declined to authorize the lethal prescription.

Kate seemed to accept the psychiatrist's verdict, but her daughter did not. Her daughter viewed the guidelines protecting her mother's life as obstacles, and in a press interview called the guidelines a "roadblock" to Kate's right to die and demanded that Kate's HMO, Kaiser Permanente, provide a second opinion. This was provided by a clinical psychologist (rather than an MD-psychiatrist) who also found Kate had memory problems. The psychologist also worried about familial pressure, writing that Kate's decision to die "may be influenced by her family's wishes." Still, despite these reservations, the psychologist determined that Kate was competent to choose death.

Sometime later, Kate went into a nursing home for a week so that her family could have some respite from care giving. After she returned home, she declared her desire to take the pills herself and approved the writing of the lethal prescription.
How safeguards failed Kate Cheney:

It is possible to circumvent safeguards by "shopping" for an agreeable professional if the patient or family disagrees with professional opinions.

By giving the interview, the patient's daughter unintentionally revealed that the law does not adequately protect patients with diminished capacity from family coercion.

Financial considerations may have influenced the HMO director to write the prescription.

Patrick Matheny
Patrick Matheny, 43, had Lou Gehrig's disease (ALS). For several months, he struggled with a decision to end his life using a lethal prescription. He would set arbitrary deadlines, then, when the time came, would set new deadlines. At first, it was to be after his 15-year-old son came to visit at Thanksgiving. Then it was to be when he could no longer dress and wash himself. As an article in the Oregonian put it, "Pat felt he would rather be dead than accept help to bathe and dress." But when the time came, he was able to handle having his mother and hospice nurses help him so he set new deadlines.

On March 10, 1999, Matheny tried to swallow the barbiturates mixed into a chocolate nutrition drink, sweetened with a boxful of sugar substitute. Reportedly, he experienced difficulty swallowing the concoction. The only person Matheny had asked to be with him in his trailer was his brother-in-law, Joe Hayes. Hayes told the Oregonian that he had to "help" Matheny to die, but would not say how. According to Hayes, it was too personal. "It doesn't go smoothly for everyone," Hayes explained. "For Pat it was a huge problem. It would have not worked without help," he added.
How safeguards failed Patrick Matheny:

Patients are required by law to self-administer the lethal drug to protect them from coercion and foul play.

Even though this violation of the law was reported in the newspapers, no investigation was done, sending the signal that the Oregon law can be violated with impunity.

Oregonian,10/27/99, 1/17/99, 3/17/99
Register-Guard, 3/16/99
Michael Freeland
Michael Freeland requested and received a lethal prescription from Dr. Peter Reagan, a suicide advocate, a few months after being diagnosed with lung cancer. Dr. Reagan offered to refill it when he outlived his six-month limit.

Over a year after receiving the first prescription, Freeland was admitted to a psychiatric treatment facility with depression and suicidal intent. He was treated and improved. His professional caregivers ensured that his 32 guns and all his ammunition were removed from his home before he was allowed to return, but they knowingly allowed him to keep his lethal prescription. His treating psychiatrist wrote a letter to the court the day after his discharge saying he was not competent and needed a guardian.

Freeland called Physicians for Compassionate Care. (He called them accidentally; he was actually trying to contact the suicide advocacy organization Compassion in Dying). Physicians for Compassionate Care volunteers helped him through his last several months of life, saw that his depression and his symptoms were treated aggressively, and assisted him in reconciling with his estranged daughter.

He died naturally and comfortably nearly two years after receiving his first lethal prescription. Before he died, he signed an authorization releasing his medical records for public review.
How safeguards failed Michael Freeland:

Freeland was given an incorrect prognosis - he was not within six months of dying.

The prescribing doctor offered a lethal prescription to a depressed patient.

Even after courts determined that Freeland was not competent and in need of a guardian, he was allowed to keep his lethal prescription.

Mrs. S.
Mrs. S. from Oregon had been struggling with a malignant lymphoma for three years. In spite of the best efforts of her several physicians, it had spread from her lymph nodes to her bones, brain and spinal cord. She had vigorous chemotherapy and radiation therapy. She had considerable pain, but this was kept under adequate control with medication. She was repeatedly discouraged, and this was helped somewhat by use of an antidepressant.

In a final visit with her primary physician, he gently confronted the fact that there was nothing more that could be done for the disease, though comfort measures could be continued. At the end of the visit, he said, "Well, I could write a prescription for an extra large amount of pain medication for you." She declined the offer and left the office. Mrs. S. and her husband were devastated. She kept saying, "He wants me to kill myself!" They interpreted his offer as saying "Your life is no longer worth living. You would be better off dead." Their longstanding good relationship with this seemingly caring physician was shattered by this new understanding of his values. Mrs. S. died comfortably at home several days later.
How safeguards failed Mrs. S.:

Such an offer by a physician is illegal under the Oregon law.
Clarietta Day
After passage of the Oregon law allowing physician-assisted suicide, but before it went into effect, Clarietta Day, age 78, had a severe stroke. She had told her longstanding physician, Dr. James Gallant (Corvallis, Ore.), that she did not want heroic measures and did not want to be kept alive on machines. Based on this understanding of the patient's wishes, Dr. Gallant (1) took her off life support, (2) gave her frequent large doses of painkillers, and (3) attempted to stop her cardiac pacemaker by placing a magnet over it. She continued to breathe. He then ordered an intravenous injection of a paralyzing drug and Mrs. Day died in 15 minutes. Dr. Gallant wrote on her death certificate that the cause of death was "stroke due to subarachnoid hemorrhage."

The Oregon Board of Medical Examiners investigated and called this active euthanasia, an action they felt was both unethical and illegal. They suspended his license to practice for 60 days. The district attorney decided not to file criminal charges.
How the unenforceable law failed Clarietta Day:

Dr. Gallant's lethal injection was clearly illegal. Was he motivated by pending new legislation that would allow doctors to hasten death?

Would this incident have been reported in the official physician-assisted suicide statistics had it happened after the law went into effect?

David Pruitt
David Pruitt, a man from Oregon with lung cancer, obtained from a physician the standard lethal prescription, and when he felt it was time, he took the entire amount. He went to sleep for 65 hours and woke up saying "What the hell happened? Why am I not dead?" He was so unnerved by the experience that he didn't want to go through it again. He died naturally about two weeks later.
Facts learned from David Pruitt:

While Mr. Pruitt's case is the first to come to public attention, repeated data from the Netherlands shows that 18-25% of Dutch people who take the same dose of the same drug as is used in Oregon do not die. They are then given a lethal injection by their doctor which is legal in the Netherlands.

The Oregon law does not allow lethal injection, and it is not known what happens to those who do not die. Deaths from physician-assisted suicide are not investigated in Oregon, and the state government says they have no way of knowing how often assisted suicide happens outside the framework of the law.

Helen X

Soon after the Oregon law allowing a physician to write a lethal prescription for a patient went into effect, Helen asked her physician for one. She had a history of breast cancer and was enrolled in hospice. She had been using a wheelchair for two weeks and had some shortness of breath for which she used oxygen. However, she had no pain and she was still doing aerobic exercises regularly. Her physician declined. Helen saw a second physician, and he too declined because he felt she was depressed. Her husband called Compassion in Dying (a group that supports assisted suicide) and they found a willing physician who wrote the prescription, though he admitted he was shaken by Helen's eagerness to die.
How safeguards failed Helen X:

Physician refusal to write a lethal prescription because the requesting patient does not meet the legal criteria need not deter a patient who is eager to die. All Helen had to do was keep asking until she found someone willing.
Barbara Houck
In January of 1999, Barbara Houck, age 71, was diagnosed with Amytropic Lateral Sclerosis, a progressive neurological disease. Almost immediately, she called Peter Rasmussen (not a neurologist, but an oncologist and a supporter of physician-assisted suicide) requesting a lethal prescription. He declined because he felt she had more than six months to live. She saw him again in March and he wrote the prescription. He was present April 10, the day she chose to die. He emptied the 90 capsules into a bowl of chocolate pudding and her two sons spooned it into her mouth. Dr. Rasmussen stayed for two hours. She died 12 hours after ingestion of the lethal drug.
How safeguards failed Barbara Houck:

It is very unusual for an oncologist to evaluate and make a prognosis for a patient with an uncommon neurological disease.

The legally required prognosis of "less than six months to live," required by the law, is in doubt.

The law requires the patient to self-administer the lethal drug. Houck received significant help from her physician and her sons.

Patient of Dr. Charles Bentz
Dr. Charles Bentz, an internist in Portland, Oregon, diagnosed a malignant melanoma in a 76-year-old man who had been under his care for over ten years. Unfortunately, the cancer had already spread to his shoulder at the time of diagnosis, so it was not curable. Dr. Bentz referred this active man to both radiation oncology and medical oncology, using two methods to slow the cancer and prolong the man's life.

When the patient finished the radiation therapy, the radiation oncologist informed Dr. Bentz that the patient was depressed due to his diminished physical stamina. At almost the same time, he finished his chemotherapy and asked his medical oncologist for a prescription so he could take his own life by suicide. The medical oncologist called Dr. Bentz, asking him to act as the required second physician to confirm the diagnosis and prognosis before he wrote the prescription, saying secobarbital "works very well" and indicating he had used it many times. Dr. Bentz responded that he could not do this; the man had a documented depression and needed therapy for this. The oncologist then found another physician to render the required "second opinion" and did not refer the man back to his primary physician. Two weeks later the patient was dead from a lethal prescription.

Dr. Bentz obtained permission from the man's family and obtained a copy of the death certificate which falsely said death was from malignant melanoma.
How safeguards failed the patient of Dr. Bentz:

The patient's well-documented depression was not evaluated by a mental health specialist, nor was it treated.

The patient's primary physician was excluded from helping him with his end-of-life concerns.

The patient's oncologist falsified a public document by lying about the cause of death.

Summary of patient stories courtesy of the Vermont Alliance for Ethical Health Care, www.vaeh.org.

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Proponents of legalized assisted suicide always point to Oregon as a shining example of how assisted suicide should be practiced. They point to "safeguards" enacted in the law designed to protect patients. Here are some real life examples of abuse and exploitation of Oregon patients: Kate Cheney Kate Cheney, 85, had terminal cancer and told her doctor she wanted assisted suicide.